“Don’t Force Healthcare On Us” Say American People

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Main Category: Public Health
Also Included In: Health Insurance / Medical Insurance;  Medicare / Medicaid / SCHIP
Article Date: 16 Nov 2011 – 11:00 PST

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Obama’s grand plans for universal healthcare slipped further into trouble today with a survey conducted by Gallup indicating that 47% percent of those questioned favor repealing the Affordable Care Act. Only 42% said the law should remain, with 11% not having a strong opinion about whether the government should mandate and effectively force people to have health insurance.

When divided into political categories, only 10% of republicans favored the law, against 43% of independents and 64% of democrats.

The survey comes at an inopportune time for Obama, whose healthcare bill is now being investigated by the supreme court to establish if it is constitutionally correct. It’s bound to become a dominant issue with the 2012 election now less than a year away, and it appears that the bill’s fate now rests more with The Supreme Court than it does with Congress.

Republicans have continued to attack the bill since it was passed in March 2010, promising to repeal it if they win the 2012 election, and Governors of republican states have taken matters into their own hands, challenging it on a state level. President Obama has been just as aggressive in defending the bill’s aims.

It seems that opinions haven’t changed much since the bill was passed, with 48% saying it was a bad thing back in 2010. A large part of the issue is simply allowing the Federal Government to encroach into people’s everyday lives in such a major way. The constitution, in theory, gives the Federal Government very little actual power and vests most of the decisions with the individual states. Some argue that even Federal income taxes are unconstitutional, thus telling people they must have health insurance was bound to draw the ire of more conservative and libertarian leaning citizens.

As a nation, there is much disagreement over whether it’s the Federal Government’s job to ensure people have healthcare, with some arguing against the nanny state mentality that prevails more in Europe, and others seeing it as a compassionate need to take care of all members of society.

The jury is still out, but the swing of opinion is obvious in the historical Gallup charts. In 2007, 69% said the Federal Government should be responsible, while today only 50% still feel that to be the case. Meanwhile, the critics of Government mandated healthcare has increased from 28% in 2007 to 46% today. In addition, 56% of people asked now say they think that the healthcare system should largely be based on private programs.

The more vocal critics against Government Healthcare point to Canada, The UK and Europe, where although healthcare is government funded, there are countless cases of: funds gone astray, white elephant projects, hospitals with inadequate funding, patients unable to obtain vital care and a general malaise that tends to dominate sectors that are not privately run, with a genuine performance and profit incentive.

By way of comparison, the telecom industry in many nations lumbered along for decades as an inefficient Government monopoly with high end user costs, and yet within a short time of being privatized, in spite of its critics, saw dramatic decreases in consumer costs and a mushrooming of competition and products available.

Taken to its logical extension, the socialism of the eastern block produced terrible food shortages that literally vanished overnight, once farmers and shopkeepers were allowed to profit from moving their produce. Sometimes its hard to argue against free market forces.

Written by Rupert Shepherd

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That is not what all the American people are saying.

posted by Ellie on 16 Nov 2011 at 11:35 am

I am saying make everyone buy health insurance. That so I don’t have to pay their bills later on when they show up at the ER demanding care and unable to pay. Health care is NOT a telecom industry it is an industry unto itself, unlike the others. Making sure everyone has insurance is not the same thing as socialized medicine. Pointing to Canada or Europe when their health care systems have nothing like Obamacare makes no sense. Maybe other people are dumb enough to believe those lies, I am not.

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Fibromyalgia Risk Greater Among Females With Poor Sleeping Habits

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Academic Journal
Main Category: Fibromyalgia
Also Included In: Sleep / Sleep Disorders / Insomnia;  Arthritis / Rheumatology
Article Date: 16 Nov 2011 – 5:00 PST

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Norwegian investigators have identified a link between sleep problems and an increased risk in women developing fibromyalgia (long-term body-wide pain and tenderness in the muscles, joints, tendons, and other soft tissues). The risk of developing the syndrome increased with severity of sleep problems and the association was stronger among women who were middle-age and older compared to younger women. Based on one decade of data, results of the prospective investigation appear in Arthritis Rheumatism, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR).

According to an estimate, in the U.S. over 5 million individuals over the age of 18 are affected by fibromyalgia, with the prevalence among the general adult population at 3% to 5%. Investigations have revealed that onset of fibromyalgia usually occurs in middle age and up to 90% of those with the syndrome are women. Although prior studies have found that nocturnal awakening, fatigue and insomnia are common symptoms in individuals with the condition, it is not known if poor sleep habits play a part in the development of fibromyalgia.

Dr. Tom Nilsen and Dr. Paul Mork from the Norwegian University of Science and Technology (NTNU) conducted a study in order to examine the impact of sleep problems on risk of the syndrome in a group of women in Norway. Women aged 20+ who had previously taken part in a large population-based health study (the HUNT study😉 by answering a health-related survey and undergoing clinical examination were included in the study. 12,350 women who had no movement disorders or musculoskeletal pain were selected to participate for the current investigation.

Results from the study revealed that 327 women had developed the syndrome – representing a prevalence proportion of 2.6% during ten years. They found that the adjusted relative risk for women who experienced sleeping “often” or “always” was 2.98 among women aged between 20 – 44 years and 5.41 among those aged 45+. According to the researchers, further investigations are required to study if early detection and treatment of sleep problems lowers the risk of women developing the syndrome.

Dr. Mork, explained:

“Our findings indicate a strong association between sleep disturbance and fibromyalgia risk in adult women. We found a dose-response relation, where women who often reported sleep problems had a greater risk of fibromyalgia than those who never experienced sleep problems.”

Written by Grace Rattue

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Neuroscience 2011 Explores New Approaches To Treating Pain

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Erectile Dysfunction Increases With Use Of Multiple Medications

The use of multiple medications is associated with increased severity of erectile dysfunction, according to a Kaiser Permanente study published online in the British Journal of Urology International. This study surveyed 37,712 ethnically diverse men from Southern California and found that men taking various medications are likely to have more severe ED…

The Future Of Kidney Disease Care

Main Category: Urology / Nephrology
Also Included In: Medicare / Medicaid / SCHIP;  Public Health
Article Date: 15 Nov 2011 – 0:00 PST

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Two studies presented during the American Society of Nephrology’s Annual Kidney Week provide new information on kidney-related policies in the United States.

Beginning in 2011, Medicare has reduced reimbursements to some dialysis facilities, which could lead to closures. Mark Stephens (Prima Health Analytics) and his colleagues sought to estimate the incremental distances patients may need to travel in the event of reduced access to dialysis care. They found that, if 3% of facilities closed over the next three years, approximately 10,000 dialysis patients could be displaced, and the additional travel burden placed on these patients would accumulate to millions of additional miles traveled.

Patients living in rural areas would be most affected. “The average rural patient would have to travel more than 20 miles extra per treatment to access the next closest dialysis facility if their currently-used facility were to close,” said Mr. Stephens.

Previous research has shown that patients who travel more than 15 minutes each way for dialysis treatments have lower quality of life and higher rates of death. Therefore, dialysis facility closures may adversely affect patients’ health and quality of life.

In another policy presentation, Asel Ryskulova, MD, PhD (Centers for Disease Control and Prevention) offered a review of kidney-related objectives of the Healthy People initiative, which provides 10-year national objectives for improving the health of all Americans.

An estimated 11.5% of adults have evidence of chronic kidney disease (CKD), and each year in the United States, more than 100,000 people are diagnosed with kidney failure, the final stage of CKD. Reflecting the importance of CKD, 14 CKD objectives were included in the Healthy People 2010 national health goals. The Healthy People 2020 initiative was launched in December 2010, and it includes new kidney-related objectives that focus on monitoring and tracking:

  • Improvements in heart-related care in patients with CKD
  • Increases in the proportion of patients with CKD and diabetes who receive recommended exams and treatments
  • Reductions in the incidence and death rate of CKD
  • Increases in CKD awareness in people with poor kidney function

It is hoped that these new objectives will help reduce new cases of CKD and its progression, complications, disability, death, and economic costs.

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Study authors for “The End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Access to Care: Incremental Distance Traveled by Displaced Patients” (abstract SA-PO2640) include John Kochevar, PhD, Samuel Brotherton, Stephan Dunning, Larry Emerson, David Gilbertson, PhD, David Harrison, PhD, Ann McClellan, PhD, William McClellan, MD, John Mark Stephens, Shaowei Wan, PhD, and Matthew Gitlin, PharmD.

Study authors for “Determining National Priorities: Healthy People 2020 Chronic Kidney Objectives,” (abstract TH-PO297) include Asel Ryskulova, MD, PhD, Lawrence Agodoa, MD, and Paul Eggers, PhD.

Disclosures available at
http://www.asn-online.org/press/.

American Society of Nephrology
http://jasn.asnjournals.org/

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Heart Failure A Greater Risk For Low-Income Older Adults

Main Category: Cardiovascular / Cardiology
Also Included In: Medicare / Medicaid / SCHIP;  Seniors / Aging;  Heart Disease
Article Date: 15 Nov 2011 – 2:00 PST

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The odds of having heart failure appear to be higher in seniors with a low income – even among those with a college or higher education – according to research presented at the American Heart Association’s Scientific Sessions 2011.

“As far as the risk of developing heart failure is concerned, lower education may not matter if a person is able to maintain a high income in later years,” said Ali Ahmed, M.D., M.P.H., senior researcher.

The study is the first to link low income with an increased risk of heart failure in Medicare-eligible community-dwelling older men and women.

Researchers said they were surprised by the influence of income on heart failure risk in a population where nearly everyone has health insurance that provides care for major heart failure risk factors such as hypertension, diabetes and coronary artery disease. Although both poor and the well-off benefit from the Medicare program, there may be certain differences that expose the poor to suboptimal care for major heart failure risk factors.

About 5.7 million Americans have heart failure, with one in five at risk of developing it starting at age 49.

Researchers reviewed National Heart, Lung and Blood Institute records of 5,153 Medicare-eligible older adults without heart failure in the Cardiovascular Health Study who lived independently in four U.S. communities in the early 1990s. They separated patients into groups based on education and income levels. Researchers defined low education as less than college level and low income as household income less than $25,000 a year.

After 13 years:

  • Eighteen percent of older adults with high education and high income developed heart failure.
  • In comparison, 17 percent of older adults with low education and high income developed heart failure.
  • In contrast, 23 percent of older adults with low income developed heart failure regardless of their education level.
  • Patients with low education and low income were worse off, with a 29 percent increased risk, compared to those with high education and high income, which was independent of other risk factors for heart failure.

Researchers accounted for age, gender, race and various known heart failure risk factors that included diabetes, high blood pressure, smoking, being overweight, and having a history of coronary artery disease, stroke or peripheral artery disease. However, researchers did not know how well controlled these factors were.

Low-income patients may be unable to pay out-of-pocket costs related to health care that Medicare provides.

“They may have to choose between their drugs and their groceries,” said Ahmed, director of the Geriatric Heart Failure Clinics at the University of Alabama at Birmingham and the Birmingham VA Medical Center. “Or the out-of-pocket expenses might adversely affect how often they go see their doctor.”

A person’s income also impacts access to healthy foods and safe, affordable places for physical activity. The study findings highlight the need to explore low-cost ways to promote healthy lifestyles, particularly access to good nutrition and exercise, Ahmed said.

Future research must also identify the specific factors that make a low-income person more likely to develop heart failure. Effective strategies can then be initiated to overcome them, he said.

Patients reported their income and education, and it is unknown whether education quality may have impacted heart failure risk, Ahmed noted.

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Co-authors are Amiya A. Ahmed, a University Honors Program sophomore and Biology Scholar; Yan Zhang, M.S., M.S.P.H.; Robert C. Bourge, M.D.; Meredith L. Kilgore, Ph.D., R.N.; Beverly Williams, Ph.D.; Patricia Sawyer, Ph.D.; Inmaculada B. Aban, Ph.D. and Gregg C. Fonarow, M.D.

Author disclosures are on the abstract.
American Heart Association

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Donating or Dumping

Donating or Dumping

Recently, I’ve seen a few interesting pieces about the wisdom of donating used medical equipment to the developing world.  The idea that it is acceptable and welcome to send one’s discarded or unwanted stuff (clothes, food, medical supplies. etc.) to those who have little is widely accepted.  Many organizations have taken this approach to address several issues.  In some cases, it works incredibly well, including: Toys for Tots, foodbanks, and Goodwill.  But, in all of these cases, these organizations have policies or procedures in place to insure that only high quality products reach the beneficiaries.

– Toys for Tots distributes only new toys because it is “legally not feasible to distribute dangerous or dirty toys” and because one of the principle goals of the program is to “send a message of hope” and “this goal cannot be accomplished through ‘hand me down’ toys.”(1)

– The Greater Boston Foodbank provides a list of the most desirable food items to donate and list guidelines for donations, including having “tolerance for expired foods but they must be no more than 3 months past expiration.” (2)

– Goodwill screens all donations against a system of quality and selection criteria and in addition to asking for items in good, working condition also have a list of items they will not accept. (3)  Given that these items are then sold, albeit at reduced rates, the market and customer preference also play an integral role in what reaches beneficiaries.

Criteria like are even more important when dealing with issues of medical equipment for the plain fact that these items are integral to life and death.  Moreover, programs that donate items to a foreign country, with significantly  different infrastructure and resource requirements and a different cultural context, must consider carefully the impact that donations may have.

The Tina Rosenberg’s commentary in the NYT online Opinator Blog highlights a few programs taking this approach.  The home page for Doc2Dock reads “Here we waste supplies, there they could save lives,” the organization redistributes the waste from US hospitals, including “unused, sterile medical supplies discarded for regulatory reasons and fully functional equipment.”    A similar organization, MedShare collect “surplus medical supplies and equipment from landfills and incinerators that, for various regulatory reasons, hospitals and medical companies must discard.”

In addition to wondering about the US policies that encourage waste, these programs bring up a few concerns, based on my experience in the developing world.  Practically, I wonder if the products that are sent are actually appropriate for the context in which they will be used.

– Infrastructure: Does it require constant electricity?  What if there are surges?  What does the plug look like?  Does it require water?

– Logistics: Does it require consumables?  Are those readily available? Are replacement parts available?  Are the products safe?

– Human capacity: Does proper use require training?  What level of professional is needed to use it?  Is that training available?  If it’s not used properly what safety issues may exist? Will anyone know how to fix it if it breaks?

A number of these concerns as well as the question as to whether these donations are impacting the market in the same way that clothing donations can (remember the 100,000 t-shirts controversy?) have been raised.  At TEDxChapelhill, Dr. Robert Malkin gave an interesting talk about how “donations hurt” focusing on these questions and the issue of lack of communication between donors and recipients and lack of accountability from donors   There is also a concern that perhaps these donations will prevent the success of local device manufacturing.  These are not new issues, and in fact in 2000 the WHO issued Guidelines for Health Care Equipment Donations that still ring true, highlighting four principles of a good donation:

1) Health care equipment donations should benefit the recipient to the maximum extent possible;
2) Donations should be given with due respect for the wishes and authority of the recipient, and in conformity with government policies and administrative arrangements of the recipient country;
3) There should be no double standard in quality. If the quality of an item is unacceptable in the donor country, it is also unacceptable as a donation;
4) There should be effective communication between the donor and the recipient, with all donations made according to a plan formulated by both parties.

While there is much good that can be done with donations, we must continue to be mindful about how they are done.  It is of paramount importance to create real partnerships in order to understand the context of the people and place, the needs and constraints of the time and situation, and to foster a long-term relationship in which dialogue exists to address the inevitable mistakes that will be made and issues that will arise.  This kind of work is not done when the contained is loaded, the ship sails, or donation arrives.  It requires commitment and collaboration in order to be successful.

 

(1) TFT 2006 Local Campaign SOP 10-2-06

(2) http://www.gbfb.org/donateFood/DonationGuidelines.cfm

(3) http://www.goodwillde.org/Donate_Goods.asp

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